Community Transportation for Underserved Populations

Government and community-based programs help meet the transportation needs of people who require specialized services. This includes people with disabilities, people with low incomes, and older adults. At the federal level, 130 programs may fund transportation services for these populations. Most of these programs fund limited transportation programs to get people to job training, health care, senior centers, or rehabilitation programs.

Program requirements differ widely. Most federal transportation funds are provided to states, local governments, and nonprofits through direct grants or block grants. Each federal funding program may require different reporting data and operate under a different funding cycle. Coordinating funding across local agencies is further complicated because the organizations often use different billing systems. The public may also find it challenging to identify, understand, and use available services.

The best programs include coordination between public agencies and private and nonprofit providers at the state, regional, and local levels. This leads to better outcomes because the agencies can transport more people more efficiently. Riders are also able to find rides more easily and conveniently. Coordinated programs are less likely to have vehicles sitting idle for part of the day and are more likely to fill up all available seats.

Mobility management: This is an approach to managing and coordinating all the transportation resources in a community. This includes public and private transit operators, volunteer driving programs, walking, bicycling, and other modes of transportation. Customers use a single point of access to coordinate multiple travel modes and providers.

Mobility management ensures that transportation options are convenient and best meet the needs in a particular community. It is especially useful for improving specialized transportation for older adults, people with disabilities, and people with low incomes.

Programs to expand transportation options for older adults: Volunteer transportation services and ride-sharing are low-cost transportation options. Volunteer-provided transportation connects volunteers willing to provide rides with those needing rides. It is an essential resource for older adults and people with disabilities who may need help meeting their transportation needs (see also Insurance Coverage for Volunteer Drivers). Ongoing challenges include recruiting volunteers, securing insurance, paying operational and administrative costs, and adhering to regulations from multiple funders.

Ride-sharing refers to carpooling and vanpooling. In these cases, a vehicle carries additional passengers when making a trip, with minimal additional mileage. A computerized carpool matching service usually facilitates ride-sharing.

Nonemergency medical transportation (NEMT): NEMT connects people without access to transportation with their nonemergency, yet medically necessary, appointments. These could be such things as kidney dialysis and chemotherapy sessions. NEMT ensures that people not only have access to care but that they can receive that care. It can help ensure that people with no way to travel to and from medical appointments do so before a medical problem intensifies.

The limited availability of NEMT and its high cost are significant concerns for many older adults, their healthcare providers, and insurers. Although Medicaid reimburses for NEMT, Medicare does so only in some limited circumstances. Some nonprofit and human services agencies provide such transportation. However, no targeted NEMT funding or program exists to meet the needs of older adults of all income and ability levels.

States may contract with brokers to manage NEMT services. Brokers manage trip scheduling, provider oversight, and claims processing. They are selected through a competitive bidding process and must be cost-effective. The use of brokers may help states control costs and improve service quality, but there is also evidence that the cost savings lead to poorer service.

Section 5310: The Federal Transit Administration (FTA) Section 5310 funding program provides capital assistance grants to buy buses and vans used to transport older adults and people with disabilities to places such as senior centers and congregate meal sites. Funding may also be used for mobility management.

Coordinated funding: In order to fully fund programs, effective state agencies coordinate financing from among federal programs. For example, many states use part of the funding from the Older Americans Act (OAA) to provide transportation services, often by transit operators under contract with the local area’s agency on aging. Typically, area agencies on aging use Section 5310 funding from the FTA to purchase vehicles. They then operate the vehicles in part with OAA funding, along with other federal, state, and local sources, including Medicaid and Head Start. The coordination of funding sources at all levels of government promotes the most efficient and effective use of transportation funds.

Innovative Coordinated Access and Mobility pilot program: This FTA program provides competitive funding to support innovative projects for those without adequate access to transportation services. The goal is to improve mobility and access to vital community services for older adults, individuals with disabilities, and people of low income through improving the coordination of transportation services and nonemergency medical transportation services.

New private-sector funding opportunities: Recent federal policy changes have created new opportunities for transportation and healthcare sector collaboration. Effective January 2017, the Department of Health and Human Services has allowed medical providers across the U.S. to provide or facilitate medical transportation for their established patients. It was previously prohibited. In 2019, the Centers for Medicare & Medicaid Services (CMS) allowed Medicare Advantage Plans to cover transportation to doctors’ offices. In 2020, CMS allowed Medicare Advantage Plans to pay for transportation for chronically ill patients to non-medical services, such as grocery shopping and banking. This has opened up new opportunities to address a critical social determinant of health for financially strapped people age 65 and older.